CLASS A ELEVATING DEVICES MECHANIC APPLICATION FOR CERTIFICATION: GRANTED/CERTIFIED DIFFERENT JURISDICTION PATH

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1 Toll Free: CLASS A ELEVATING DEVICES MECHANIC Payment Card Industry Data Security Standards prevent the use of credit card information sent through or fax. A Client Service Representative will contact you within three business days to complete any payment process required. Note: The information on this form is collected to administer the provisions of the BC Safety Standards Act and section 26 of the Freedom of Information and Protection of Privacy Act. If you have questions about the collection, use or disclosure of this information, contact the Records, Information and Privacy Analyst for the Technical Safety BC at Part 1: Application Package Instructions Please review the contents of this package before completing it. This package contains all of the information and forms you need to apply for a Certificate of Qualification for the trade of Elevating Devices Mechanic Class A. The purpose of this package is to assist you in collecting the information we need to complete the assessment of your application. Technical Safety BC will assess your work experience and determine if you qualify for this certification path based on the information you provide. The Technical Safety BC will process your assessment and will notify you in writing of the results of your assessment. Applications will be returned if information is missing. We cannot process incomplete applications. Sections: Part 2: Part 3: Part 4: Part 5: Part 6: Part 7: Applicant Information (page 2 of this package). To be completed by the applicant. Applicant History (page 3 of this package). To be completed and signed by the applicant. Employer Declaration (page 4 and 5 of this package). To be completed and signed by any current or previous employers where you have acquired work experience you want assessed as part of your application (page 4 section B). The Employee s Representative may also complete and sign the Employer Declaration form in situations where employer records are incomplete or unavailable. Document Checklist (page 6 of this package). To be completed by the applicant. Supplemental Training Checklist (page 6 of this package). To be completed by the applicant. Application and Examination Policies (page 7 of this package). To be kept by the applicant for future reference. All documents must be submitted in English. Translations of documents in languages other than English must be done by a certified translator. You are responsible for the cost of translation services. For a list of certified translators, contact the Society of Translators and Interpreters of British Columbia, or visit their website at NOTE: For your own records, you may want to keep a copy of this submission package. FRM ( ) Page 1 of 7

2 Part 2: Applicant Information A. Applicant Information Last Name: Legal Name Given Name: Middle Initial: Date of Birth: MM / DD / YYYY Civic Address: Suite No: Street No: Street Name: City: Postal Code: Mailing Address: (If different from above) Suite No: Street No: Street Name: City: Postal Code: Primary Phone: Mobile Phone: Contact Preference: Mail Other: B. Exam Details Once this application is approved, you will be notified to schedule your certifying exam. Exam sittings may be scheduled as of January 1, 2014 at any of the following Technical Safety BC office locations: Kamloops, Kelowna, Langley, Nanaimo, New Westminster, Prince George, and Victoria. C. Certificate Details Issuing Province Issue Date Expiry Date Certificate Number Scope of Work Listed on Certificate D. Payment Details 1. Please ensure the correct payment amount is made with this application. Make sure you include the correct GST amount in addition to the fee listed on the fee schedule. Fees can be found at 2. Though Technical Safety BC accepts applications as of July 1, 2013, we will start processing payments on July 15, If you are making a payment via Visa or MasterCard, Technical Safety BC staff will contact you for payment on or after July 15, Do not write down your Visa or MasterCard number on this application. 4. If you are making a payment via debit or cash, you must submit your application in person at one of our offices on or after July 15, If you are making a payment via cheque, make the cheque payable to Technical Safety BC. Make sure your cheque is submitted with this application. Your payment will be processed on or after July 15, Please indicate your payment method. Visa MasterCard Debit Cash Cheque FRM ( ) Page 2 of 7

3 Part 3: Applicant History A. Applicant Information Legal Last Name: Legal First Name: Legal Middle Initial: To qualify for a Certificate of Qualification for the trade of Elevating Devices Mechanic Class A, you must provide proof of having worked a minimum of 8,000 hours performing the tasks listed on the Employer Declaration (page 4 and 5 of this package). B. Employment Summary Information Name of Organization / Employer(s) * Dates of Employment Total # of Hours of Experience * Note: An Employer Declaration form (page 4 and 5 of this package) must be completed by each of the employers listed above. See Employer Declaration Instructions to Employers for additional information. C. Signature Checking this box and submitting this form to Technical Safety BC via constitutes your authorization. This has the same effect as submitting a handwritten signature. Applicant Name (please print): Applicant Signature: Date : FRM ( ) Page 3 of 7

4 Part 4: Employer Declaration Instructions to Employers Each employer listed on the Applicant History form (page 3 of this package) must complete an Employer Declaration form. Please make additional copies as required. The information that you provide will be used to assess and to validate the applicant s work experience in the trade of Elevating Devices Mechanic Class A. Assessment applications will be returned if information is missing. We cannot process incomplete applications. A. Applicant Name Legal Last Name: Legal First Name: Legal Middle Initial: B. Employer Information Name of Organization / Employer / Business: Contact Name: Contact s Position / Title: Suite Number: Street Number and Name: City: Province: Postal Code: Phone Number: Fax Number: Address: C. Employment Information Dates of Employment Total Number of Hours of Experience D. Declaration Response By checking the box, indicate whether the applicant has performed the following tasks at the level of competence of a lead mechanic during the applicant s period of employment with the organization indicated in section C above. If any box is not checked, the Technical Safety BC will assume that the applicant has not performed that specific task. Worksite Safety Completed 24 hours of worksite safety training Demonstrates safety on worksite through compliance, safe work practices, and safe use of tools and equipment Elevating Device (Endorsement) Installation / Construction Maintenance Elevating Devices Tasks (Scope of Work) Alteration / Repair / Service Traction Passenger Servicing braking systems Replacing controllers/drives Re-roping Replacing machines/motors Replacing governors and safeties FRM ( ) Page 4 of 7

5 Elevating Device (Endorsement) Installation / Construction Maintenance Elevating Devices Tasks (Scope of Work) Alteration / Repair / Service Traction Freight Hydraulic Passenger Hydraulic Freight Escalators / Moving Walks Lifts for Persons with Physical Disabilities Wind Tower Lifts Servicing braking systems Replacing controllers/drives Bi-parting door systems Repairing hydraulic systems Upgrading hydraulic systems Repairing hydraulic systems Upgrading hydraulic systems Bi-parting door systems Repairing escalators/moving walks Re-roping Replacing machines/motors Replacing governors and safeties Replacing motors Replacing controllers Replacing jacks Replacing motors Replacing controllers Replacing jacks Certification: I certify that the information I (as employer) have provided is accurate. Employer Name (please print): Employer Signature: Date : FRM ( ) Page 5 of 7

6 Part 5: Document Checklist To avoid delays in processing, please use the following checklist to ensure that the required documentation is attached to your application and all forms are complete. We cannot process incomplete applications. All applicable boxes must be checked off: The application, including letters and certificates, must be originals or certified true copies of originals, in the English language. Any translations have been performed by certified translators. The applicant has completed in full the Applicant Information form (page 2 of this package). The applicant has completed in full and signed the Applicant History form (page 3 of this package). The applicant has provided either of the following as verifiable evidence of employment: Copies of paystubs Copies of pension statements Copies of government issued documents Original skills passport issued by a different Canadian jurisdiction Each employer has completed in full and signed the Employer Declaration form (page 4 and 5 of this package). Scope of work and endorsements The information on the Employer Declaration form matches the information declared on the Applicant History form. Part 6: Supplemental Training Checklist Proof of attendance to and course completion: Safety Standards Act; BC Elevating Devices Safety Regulation; Safety Standards General Regulation (4 hours). Office Use Only Application Review Date Screened: MM / DD / YYYY Missing Information: Results: Hands-on work experience: Scope: Required: 8,000 hours Reported: Required: 24 hours of worksite safety At least one of the Elevating Devices Tasks for any listed Elevating Device Reported: FRM ( ) Page 6 of 7

7 Part 7: Application and Examination Policies Your application may be subject to audit. Please ensure that you have all documentation associated with your application. Ensure that you have reviewed and understand the following policies and information before submitting your application. You may keep this page for future reference. Policies 1. Incomplete application(s) will be returned to the applicant. 2. The Technical Safety BC will not be able to accommodate clients wishing to reschedule exams within 3 days of the scheduled exam date. 3. Re-schedule requests will be charged a re-scheduling fee (plus tax). 4. Clients who do not show up for an exam sitting will be recorded as a no show. Subsequent requests will be charged the exam fee plus the re-scheduling fee (plus tax). 5. Rescheduled exams must be written within 60 days following the original scheduled exam date. Clients unable to write within this time will have to re-apply. 6. An examinee who arrives late will be penalized for the amount of time they are late. 7. An examinee not scheduled and approved to write on a particular exam day will not be allowed to write. 8. If an examination candidate fails to pass an examination on their first attempt, the candidate may not take the examination again until 30 days after the previous examination. 9. If an examination candidate fails to pass on their second or third attempt, a Provincial Safety Manager may stipulate terms or conditions in respect to the length of time that must elapse before the candidate may take the exam again. The Provincial Safety Manager may suggest an upgrade course to be successfully completed. 10. When an exam is rebooked, the fee for a rewrite is determined by the latest fee schedule. 11. Examinations will start and end on time. 12. Candidates must provide a government-issued picture ID or equivalent to the invigilator prior to writing the examination. 13. No cellular phones, blackberry(s), camera or any other type of communication devices are permitted in examination room or to be used during the examination period. 14. The only material allowed in the exam room is appropriate Code Books and reference material as specified in the syllabus, non-programmable calculators, non-technical and/or language dictionaries, highlighters, pens, pencils, erasers and rulers. 15. No notes should be made on reference material or pages removed from reference material provided. The questions are not to be recorded and taken out of the examination room. 16. Examinees are not permitted to leave the examination room, once the examination has started, without permission from the invigilator. The examinee should make every effort to remain in the examination room during the examination period. Under no circumstances will more than one examinee be permitted to leave the examination room. 17. All questions are to be directed to the invigilator. The invigilator will only answer questions on an administrative level. All other questions are to be recorded on the Exam Evaluation Form that is provided in the exam package. 18. There is no communication between the examinees, at any time, during the examination. 19. Completed examinations and all papers provided must be returned to the invigilator at the end of the examination. Examination information and fees can be found on the Technical Safety BC website at FRM ( ) Page 7 of 7